I try not to obsess about the modern environmental threats to human health, but each trip to my children’s dentist makes me grimace. The warning stickers on the X-ray machines jump out at me like flashing red lights at a railroad crossing. I’m barely seated in a chair across from an X-ray machine before a cheery dental assistant breaks my stare with an announcement that it is time for my sons to have “photos” taken.

Let’s call them what they are. X-rays are not photographs. They’re radiographs, as in radiation. Perhaps my nursing education made me antagonistic towards routine X-rays. I recognize that X-ray is an important diagnostic tool, but it is not without potential for serious harm. There is good reason why radiologic technologists ask women repeatedly before undergoing X-ray if there is even a smidgeon of a chance they could be pregnant. Radiation, particularly in accumulation, can damage human cells and increase risks of developing cancer.

Our most recent visit to our pediatric dentist resurfaced my X-ray fear. I knew I’d displease the dentist by with a refusing more X-rays. I’d declined them at the visit six months prior, but the persuasion attempt was much weaker then.

The dentist claimed she needed X-rays to check for cavities between teeth. According to her, these should occur at least annually and certainly no longer than 18 months from the most recent set. She said without them she was unable to give my 9-year-old son a “clean bill of health” and would document in his chart that I refused X-rays. Though he has a history of tooth decay, she found no breakdown on a visual inspection. Still, I declined.

I allowed her to take X-rays of my 6-year-old son’s teeth because he’d never had them before, nor had she found any cavities on a prior visit. I told the dental assistant that this was not a procedure I intended to repeat. She found cavities on the X-ray, but she had already found two of the three on a visual inspection. They’ll be filled next month, and I’ll continue waging a war against near-constant Gatorade consumption.

 I don’t know when taking X-rays of children’s teeth every six months to check for cavities became routine. I don’t remember having it done as a child, but perhaps my memory is foggy. According to the American Academy of Pediatric Dentistry (AAPD), X-rays should not be routine. They are “recommended only when necessary to evaluate and monitor your child’s oral health.” I suppose that means X-ray use is dentists’ discretion. Is profit a motivating factor? I understand dentists want to provide as thorough an exam as possible. The flip side is murky, but enough medical research exists to warrant concern.

In Pediatric Radiology, a 2007 study of 17 children who had panoramic dental X-rays taken showed statistically significant increases in levels of oral cell death and nuclear alterations after the films were taken. Repeated exposure to cytotoxic agents like X-rays can result in chronic cell injury, thus increasing potential for tumor formation.

Colgate toothpaste provides on its website information reviewed by faculty at the Columbia University College of Dental Medicine regarding the safety of dental X-rays. According to the site, no one knows the exact effects of low-dose radiation, and dental X-rays have never proven the cause certain cancers. I don’t doubt that, but dental X-rays are among numerous sources of radiation in our environment. If radiation harm is cumulative, shouldn’t I eliminate exposures I deem unnecessary?

 The AAPD says I’m wrong to deem repeated X-rays to check for cavities unnecessary. The risk is minimal because of technological advancements to reduce X-ray scatter and exposure strength, the academy claims. It further argues “dental X-rays represent a far smaller risk than undetected and untreated dental problems.”  Are cavities between deciduous teeth that difficult to find, and is finding them every six months via X-ray worth the shot of radiation?

I hope parents will seek information on the issue of childhood dental X-rays and make informed decisions. I encourage parents to not rubber-stamp these procedures. Understand why they’re being done, decide whether they outweigh potential risks and be confident in a choice whether to allow them.